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ADA Request
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Contact Information
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Modification Request
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Contact Information
Review Process
The review process, concluding with the approval or denial of the requested modification, shall be completed within 15 working days from the date of the request, unless the requestor and the City agree to an extension of time.
If the request for modification is approved, it will be provided without undue delay. The City will notify the requestor and make the necessary implementation arrangements.
If the City is unable to provide the modification that was requested and the alternative solutions won’t meet the need, the requester may appeal to the Assistant City Manager as provided for in the City’s Grievance Procedure and described below.
Appeal Process
Decisions on reasonable modification may be appealed to the Assistant City Manager through the City’s ADA and Section 504 Grievance Procedure. An appeal of a denial to provide a modification must be made by the requestor and/or designee as soon as possible but no later than 60 calendar days from the decision to deny the modification to: Assistant City Manager, Rockville City Hall, 111 Maryland Ave, Rockville, Maryland 20850. See Grievance Procedure at www.rockvillemd.gov/ for complete instructions and details governing the process.
The City of Rockville is committed to the Americans with Disabilities Act and Sec. 504 of the Rehabilitation Act of 1973. To request this form in an alternative format, contact us at 240-314-8108 or via
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Modification Request
The modification will allow me to participate in the following City program or service or to access the following City facility:
The modification I am requesting is described below (if it is a purchasable item, please provide the model number, cost, and where it can be obtained):
Describe how this modification will assist you:
I attest that I have truthfully provided City staff with adequate information to make a modification that will enable my participation in City programs, services, and facilities.
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